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I Worked At A Hospital For The Criminally Insane. Ask Me Anything.

I was an adult education instructor (a teacher) and I worked at a state institution; one part is a prison for the criminally insane, the other part contains the chronic wards. I worked there for ten years. I am currently retired.
Brainyblonde Brainyblonde 66-70, F 46 Responses May 20, 2010

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Was it scary?

Yes, at times things erupted and I did get hurt a few times (minor injuries) by patients. But to me the most frightening part of my job were the corrupt, incompetent and plain evil hospital administrators. THEY were truly the scariest part of working in a mental hospital.

Hi, I am studying psychology and would like to use this to rehabilitate serious offenders. Council them etc. I am not sure how close this is to your line of work? And I don't know the correct career label for this or how to actually go about this job. if you could help at all i'd be very grateful thank you.

Your best way of finding out which job to aim for is to visit or volunteer for a public mental hospital or forensic institution. By spending time there, you will get to talk to people who work there and learn about various jobs. Talking to someone in the Human Resources office at one of these institutions could also be helpful. Some possible jobs you might consider: Psychiatric social worker, rehabilitation counselor, rehab therapist, psychotherapist....each state or system is different.

I really want to work with the criminally insane, i'm 19 years old and currently doing criminology, How would i go about getting a job going into that sort of work? am i on the right course or would i have to do mental health nursing! It's my dream job and i'm just confused of how to get to that stage

What is the average starting salary for people like you.

My salary was about the same as any school teacher in the CA public school system, maybe a little less (with slightly better retirement benefits).

Thank you for opening this conversation and your willingness to share what you have experienced and your candor. I have a daughter I'm very concerned about that has a combination of personality disorder superimposed on closed head injury, superimposed upon years of methamphetamine addiction. She is unsuccessful in any type of Probation and in the prison system thusfar; they are not sure what to do with her. I am in fear she may land in a place we all have seen horror movies about yet she is dangerous in the community. She has two children she has lost rights to due to her behavior and if you cross her you better get ready for a backlash of epic proportions. I love the child I brought into the world but this person I just want to shake and say "who are you and what have you done with my daughter?" I long for her to find a placement in a facility where she can receive some real mental help, supervision and a positive peer culture where she can be called out on her behavior. I am hoping you can say there is hope for some in these facilities. Again thank you for sharing. IM

I am sorry I took so long to reply to this. And I am sorry you have had to go through so much over your daughter. What you describe doesn't allow for an easy answer. There's no known cure or medically agreed upon treatment for personality disorder. Or patterns of sociopathic behavior. And if she is in a public mental hospital or forensic facility, at least in the US, she will not be surrounded by a positive peer culture nor will anyone call her out on her behavior because of the fear of lawsuits that permeates the system. A good private institution might be able to provide a more therapeutic social atmosphere but it is highly debatable whether this would really have the power to change anything significant for her, especially if she isn't strongly motivated to change. I know that sometimes life skills classes, education in general and good long term psychotherapy have proven useful for highly motivated people who badly want to improve their lives. In general, personality disorder, and character disorder, are considered fairly intractable. I wish I could say something more helpful or hopeful here but that's all I know about it. I do know that there is every reason why you should not blame yourself for any of this, no matter what you have or haven't done as a mother. There are so many factors that go into a situation like this, genetics are a strong factor, as are personal choices your daughter has made herself. I know you are doing all you can for her, so please do be kind to yourself and do not allow those who blame you to drag you down into a depressive state of mind. Frankly, I am more concerned about you and your mental and emotional health at this point. Take care. You are doing your best.....r

Is meditation offered to the patients?

When I was there, yes, there were some meditation classes taught by volunteer instructors.

Great story. You must of seen it all. I work construction. Built a Mental hospital for the state. Yes, they had some Nasty ,violent people there. Lucky, this was a new wing. We were safe there. But you had to *keep an eye out* for the wayward patient.
XXX Crowbar

While you did say that you were a teacher, did you have any access to patient interviews? I'm interested in modern patient vs management protocol in recorded interviews. Furthermore, while I'm aware that there's always variety within patients - what was your general patient response in the classroom, in a sense of behaviorism? What you've experienced in your career is a fantastic representation of modern institutions. I think it's fantastic that you're offering such information.

Thank you!

I was not sure what you meant by patient interviews; I worked in a classroom and acted pretty much as a teacher does in any adult school. The hospital did intake interviews as did psychiatric social workers assigned to the patients. In general, they did not allow patients to go to school who were not considered, by their medical team (psychiatrist, social worker, therapist(s), sometimes others) as \"school ready.\" Most adult patients, especially in the forensics section, were highly motivated although sometimes handicapped by their mental condition; I was not a Special Ed. teacher; I taught those who did not have learning disabilities though they had other problems, obviously. The adults in the civil commitment side, mostly the so-called \"personality disordered\" patients, were often less motivated than the patients in the forensics side. When you say \"behaviorism,\" I assume you do not mean a school of psychology, but mean how the students typically behaved. In general, behavior was good because the ones who go to school or high functioning and they are, for the most part, there in school by their own choice. It can take months for a patient to get permission to go to school so most of them do not want to make any trouble. However, since they are troubled and mentally ill people, things do occasionally erupt and when they do erupt, it is often sudden and unnerving. There are a lot of people around ready to help under such circumstances, so the teacher is far from alone if something like this happens.

Again, as I have told others here, you will need to find out in what places you might actually want to work and then either go there or phone and find out what types of psychologists they hire and what types of jobs do they have a very hard time filling. Criminal psychology is one area of psychology while forensic psychology can involve crime solving skills as well as psychology. I could be wrong about this so check it out. There is no substitute for talking to people who do these kinds of jobs. Most of the time, they will be happy to tell you all about their careers, how they got started etc. Volunteering, even for a couple of days, would be really helpful if you can do that. Each state is a little different, each institution is slightly different, so you have to check it all out, if only by phone.

I saw the movie " One Flew Over the Cookooes Nest" again the other day. Good book. I heard the author (Ken Kessy) took acid while being a night watchman at a asylum. On doing research for the book.
In reality to me it is a very sad situation .

I have read the book, have even met Kesey himself. It is a good book. However, you should know that public mental hospitals today do not resemble what Kesey wrote about. There are several reasons for this. Legal changes and huge changes to the kind of populations that now inhabit mental hospitals (very different from back in the 60s) have changed the atmosphere of these state hospitals quite a bit. While there are still mindlessly authoritarian types who enjoy having power over patients, these types have a lot less power than they used to. Also, patients are not what they were; back in the 80s, during the Reagan Administration, the delusional patients were let out of the mental hospitals on the grounds that they could be cared for by local community mental health centers because nowadays we can often help many kinds of delusional mental illnesses with drugs. But the funding for those community health centers never materialized and most delusional people are not capable of managing their own lives, let alone getting a prescription filled (with money they don't have). So the delusional indigent patients, who really do need to be in a public hospital, are currently known, for the most part, as "the homeless." That phrase never existed when Kesey wrote his book. At that time, delusional people were generally inside institutions, not on the streets. In order to keep their funding and their own jobs, the ignorant, politically driven public mental hospital administrators decided to take in a whole new type of patient to replace the delusional people whom they now had to put out onto the streets. So nowadays they accept so-called "personality disordered" people; these people are not, strictly speaking, suffering from a mental illness, they have a "disorder," which means a collection of symptoms somebody gave a name to. They have a condition that handicaps them socially and makes everyone around them angry and upset but they are not mentally ill or completely unable to care for themselves......until they have been in a public hospital for a while, then they get addicted to it because they have no real responsibility and can live like bratty children who never grow up. There is no known cure for "personality disorder" and, in fact, there is no generally agreed upon medical treatment that is known to help. No cure, no treatment, but yet they remain in the hospital, not getting better and sometimes getting worse. In everyday, real life, a lot of these personality disordered types are known as "A_______s." It is a true waste of public funding to keep these people locked up in a hospital when they do not get any better. And they take up the room that all of those delusional people used to occupy. Truly crazy! If Kesey were writing his book today, it would be a very different book. The only thing that the two eras of mental health history have in common in that neither situation made much sense or did much to help indigent patients in mental hospitals.

Yes the book was better than the movie.
When I was a roll-back driver, I was assigned to deliver fork-lifts to a mental hospital out side of MacClenny FL. While waiting on paperwork at location. A group of patients came out side where I was. They asked for cigarettes, I don't smoke. There mannerisms, hygiene and dress told me something wasn't right. To me it was sad.
I always look forward to broadening my horizons and learning more. There is so much in different cultures, occupations, attitudes and the way things are done that I thirst for more.

Thank you for your comment. The dependency makes me sad. Some patients have to be in a hospital but most of them have simply become dependent on being taken care of by the state.

Wow, I've always been interested in being a psychiatrist and working with the criminally insane. I read up on a hospital called broadmoor and some of the people that are admitted there. Is there ever any situation which are dangerous. Or is it always very safe?

I chuckled when I read your post. On the first day of my first training session when I first started, the trainer guy said, "If you are worried that you might get hurt in here, you can stop worrying about it right now....because you WILL get hurt in here if you are here long enough. It would be a rare thing for someone to work here for a year without getting hurt. So if you want to leave, the time to go would be now

Wow that's crazy, thanks!

Everyone who works in such a place will get hurt sooner or later, but it is usually, for most of us, minor injuries and not very often. Most of the time, it is calm sailing but every so often something erupts and when that happens, it is sudden and often out of nowhere. Every so often, you hear of someone getting killed. In each of these cases, it comes down to one of two things, though officially these things are never, ever admitted. Either the person was basically naive and could not wrap his/her mind around the idea that very sympathetic and charming people whom one could like can be dangerous people, or the person was from outside the hospital (usually from the Registry, kind of like a "substitute nurse" or substitute employee) and was doing something illegal with a patient that required they be alone with that patient (buying or selling illicit sex and/or drugs, usually). I have never known anyone who got seriously injured or killed who simply used a modicum of common sense and who followed the basic rules and policies of the hospital.

There are many paths to working with mentally ill criminals or sociopathic personalities. You need to find out exactly what area you wish to work in and then talk to someone who is doing the kind of job you would like to be doing. Then that person can tell you the path to get there. Often, a volunteer job can help a young person know if this kind of work is right for him or her.

First, figure out what you want to do. Then, get the necessary degrees or licenses. Some of the best jobs in these types of institutions are jobs requiring a 2 yr. degree.

At the moment i work with people who are 'challenging' but would love to work in a hospital/ prison for the criminally insane. How would i go about that? Thanks :)

Sorry it has taken me so long to answer. I have not had an Internet connection until recently. If you are in the US, you can go to the State system for getting jobs working for the state and then apply for entry level jobs in public mental hospitals, especially the ones that are also prisons. You can also locate a public forensics hospital (prison hospital) and go there and talk to someone in the Human Resources Dept. and ask him or her what jobs are most in demand. At my former place of employment, a public forensics hospital, it was rehab therapists, physical therapists and psychiatric social workers.

how do i get a job working with the criminally insane?

I hope the answer to your question is in some of my other answers here. If you have any other questions feel free to message me.

I'm a student majoring in psychology. Would this major help me work with the criminally insane?

Yes, but take the psychology classes that are offered in the Criminal Justice program, in other words, Criminal Psychology. The best way to know exactly what classes or major to take would be to talk to a Human Resources person at the kind of institution you would like to work in. Look at the kind of jobs they have and volunteer if you can. Talk to people working there while you are volunteering. Even one day of volunteer work can teach you a lot about how you might fit into such a job.

I would love to work and help the criminally insane, some people make think I'm crazy but I would really love to help them.

Bear in mind that you would not be able to help most of them. You would have to settle for occasionally being able to make a real positive difference in the lives of some of them. Some people have mental conditions and illnesses that we do not know how to cure. Some people do not want to be cured or to change. Some people enjoy making others afraid of them. Some people feel safer locked up. It can be a very discouraging job at times. However, there is certainly nothing crazy about wanting to get into this kind of work.

I really would love to be a psychiatrist for the criminally insane. I know, your a teacher, but what kind of degree would I have to have and what is the exact name of a psychiatrist who works with the criminally insane? Thanks so much for your time :)

A psychiatrist who works with the criminally insane is simply called a psychiatrist, with an area of specialty, Criminal Psychology. A psychiatrist is a doctor. He/she attends medical school, becomes an intern in psychiatry and gets a medical degree with a psychiatric specialty. Most of the time, the psychiatrists in the hospital did not do any kind of "talk therapy," they just decided what drugs to prescribe patients. Frankly, I thought that most of them did little good although some were able to help some patients. Psychologists, who do not make nearly as much money, and who do not have nearly as much status and power, are the ones who actually deal with patients in a meaningful way. Also, psychiatric social workers, who are social workers specializing in psychiatric patients, work with patients one on one and often do a great deal of good helping patients get their lives back.

I would love to work with the criminally insane. Every website I look tells me I need different degrees. What degrees do you have?

I am a teacher with a K-12 teaching credential. I also have a four year degree in Admin. of Criminal Justice. I also have a couple of other degrees (M.A. Eng. Lit., 4 yr. Educ. degree). The way to find out what kind of degrees you need is to go to an actual hospital of the type you would like to work in and ask the Human Resources person, "What kinds of jobs are the ones you have a hard time filling? What kind of degree would be most helpful here?" Also, talk to people who work there. A volunteer job, even for a few days or a week can tell you a lot. There are many, many jobs in the criminal justice system and each state or country is different.

What are qualifications to be admitted? What were your majors? What qualifications do you need for the job? What's the difference between this and a psychiatric unit at a hospital? What is the discharge process and where dO they go from there?

I assume you mean how are people admitted to a public mental hospital in CA. There are two parts to the hospital where I worked, a public CA mental hospital. One part for for civil commitments; people whose families could not manage them and who did not have enough money or insurance for a private hospital. Also, sometimes street people who get arrested a lot get committed by a judge if they are believed to be a danger to themselves or others. The other side of the hospital was called a "forensics hospital" which means a prison, basically. In the latter case, a judge or jury found the person to be criminally insane, that is, they were adjudicated as "Not Guilty By Reason of Insanity," which means they were believed to have not been responsible for their actions at the time of the crime (no other time is taken into account, just the time of the crime). Also, in the Forensics section of the hospital, there were people convicted of serious crimes who were permitted, by order of the judge, to serve their prison sentences in a mental hospital.

The difference between where I worked and a psychiatric unit, is that a unit is one part of a hospital. Often it is a county hospital or a private hospital. The place I worked was a public mental hospital; everyone there was there because they were seriously mentally ill (or believed to be).

I majored in English and got a teaching credential. I worked in a juvenile detention center for about 15 years before I got the job at the state hospital. I also have a degree in Criminal Justice and this was helpful, along with my experience, at getting the state job.

The discharge process for those in the Forensics side of the hospital is a slow and difficult one, basically depending on the judge who originally sentenced the person. There are several discharge programs demanding different types of patents and different requirements. Usually, a psychiatric social worker, in cooperation with the judge and other members of what the hospital calls a "team" decide which discharge program is best for which patient. Then the patient, if he/she agrees with the plan, has to meet the criteria that program demands for discharge. There are often halfway houses or other publically funded organizations that take care of the the next step.

For those in the civil commitment area, discharge is much easier. The criteria for discharge is decided by a team that usually includes a social worker, psychologist, psychiatrist, and anyone else who works directly with the patient such as a teacher. In civil commitment cases, there are halfway programs and, in some cases, they will go back to live with their families.


My hats off to you!<br />
Do you see any peaple who in your opinion should not be there???

YES. Lots of people here would be better off in a much different kind of program. If you are a delusionally mentally ill person, a public institution can sometimes help, at least as well as a private one. But if you are so-called "personality disordered," the program here really doesn't do much for people like that. Borderline personalities thrive at this place and they don't want to get out because then they would have to either control their behaviors or wind up in jail. In my opinion, most borderline personalities here get worse over the years, not better. And, of course, some people wind up here just because they are really weird, have strange habits or personalities so they cannot fit into socieity...but they do not real harm and it seems a shame that they can't find more acceptance in society in general.

that is so sad! I could not work there I would get depressed. I had a job working on clinac machines that radiated on peaple with cancer. I had to leave, it was to sad seeing the patients.

I know I would have found that very hard.

I just wanted to tell you that I am proud of what you do. Not many could handle your job.....Thanks for all that you do, and for being the person you are........A Good Friend, and an honest person.. =)

That is very kind, and, frankly, more kindness than I deserve; I wound up in this job partly due to luck and partly due to career interests.

so im a senior in high school, and i graduate in may, i start college next fall and i need to be figuring out what i wanna do. my passion is people. i think everyone is beautiful and unique in their own way.. what i wanna do, and my dream for many years has been to work with the criminally insane and/or the mentally handicapp. more the criminally insane, then the hadicapp...but im okay either way.. but after my research and talking to my college physcology professor,,, i was suggested that i take up clincal neurophyscology as my major.... does that sound right? to get me to where i want to be? please let me knoww.... thank you sooo entirely much (:

Rather than talk to a psychology professor you might want to talk to a Human Resources person at the kind of institution where you might want to work. Ask them what kinds of jobs are available and which ones are hardest for them to fill. Make your job connections before you get the degree. You may only need a four year degree to get your first job. I know that rehab therapists are very much in demand at the hospital where I worked. Also, they hire a lot of psychiatric social workers. I am not familiar with neuropsychology but suspect that they do not hire them much at state institutions because they use psychiatrists for that in those places most of the time. But check it out, preferably by actually going to, or volunteering at, a public mental hospital or prison. If you cannot do that, then plan on spending a morning making phone calls to talk to people in the Human Resources offices at these public institutions. Also, you might want to go to your State employment office, the place where they list all of the state jobs and talk to someone there. There is really no substitute for actually talking to people who work in these places.

Good Evening Brainyblonde. This is my first visit to this great website -- Experience Project -- and your pedagogic skills are much in evidence. That you're a writer too is a big plus.<br />
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I'm too old for career guidance at this point, but I'd certainly appreciate any information you have time and inclination to share with me about psychiatric hospitals. Please let me explain.<br />
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I'm doing research for a novel, a portion of which is set in a fictitious asylum 1965. I don't think it's necessary for me to immerse myself in the subject matter. The asylum portrayed is more tangential to the story than its essence. Still, though, I don't want to play fast and loose with the realities of mental health care.<br />
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So before I go any further let me ask you if you're okay with advising a fiction writer? If yes, I'll run past you what I want to accomplish fictionally and then ask you if my scenario has any legitimacy in the real world. For the moment I'm thinking a state mental hospital in a rural location somewhat resembling the real one in Ukiah.<br />
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Sincerely, William

Feel free to message me. But please remember that mental health facilities were very different in many ways back in 1965; they were a lot less like what I have experienced and much more what Ken Kesey experienced back then.

Hope your writing project is going well, Let me know if I can help.

How does one ascertain if a person on trial for murder is sane or insane?

The legal question would be: Was that person of sound mind ("sane") at the time the crime was committed? No other time would be in question, just the time of the crime. Most states and most English speaking countries still use the M'Naughten rule: People are considered "sane" enough to stand trial if they knew right from wrong and knew that what they were doing was wrong. Sometimes other evidence is considered, such as being incarcerated for mental illness at the time of the crime.

Are there any "infamous" newsworthy types in your facility? (I know you cannot answer due to confidentiality laws) Just a broad hint...?

Yes. And you are right. I can't name any due to medical confidentiality issues (HIPPAA). (A "hint" is the same as telling from a legal perspective). We have had both the famous and the infamous here at various times.

I don't know if you can answer this or not but.....i have a very good friend who has been diagnosed with borderline personality disorder. She has been confined to a similar institution for over 2 years now. She is on the treatment side of the facility not the criminal side. In your experience what do you think the chances of someone confined that long has of making a full recovery at this point

Unfortunately, from where I stand, her chances are not very good of having any improvement. As any psychiatrist, psychologist or psychiatric social worker will tell you, or any basic psychology textbook, there is no known cure for personality disorders, and borderline personality disorder is generally seen as fairly intractable. What is worse is...there is also no generally agreed upon effective treatment for it. In other words, they don't know what to do about it. Since these patients are usually intelligent and high functioning, they really know how to play the system and they wind up being very powerful in most institutions. The staff are more afraid of borderlines than they are of violent sociopaths or delusional people. People with this kind of problem tend to become instituionalized, that is, they become so accustomed to a situation in which they have a lot of power and in which everyone basically caters to them that they do not do much to try and become suitable to live in the outside world. If your friend really, genuinely wants to make some progress, then she should attempt to take as many life skills classes as she can. Also, look up the Maryland Institute's paper, "The Characteristics of Emotional Maturity." (You can Google it online). Those are the skills she needs to develop in order to make it outside an institution. She is not really "mentally ill" because personality disorders are not, strictly speaking, mental illnesses; they are a collection of symptoms that doctors have given a name to. Personality disorders are often just bad upbringing combined with little opportunity to develop socially or emotionally. Some hospitals offer psychotherapy and if she can do this, she should, assuming she is willing to work with the therapist to develop the skills outlined in the Maryland Institute summary of emotional characteristics. (It is only one page long and is easy reading). Most borderline personalities get a lot out of being the way they are and change is hard for them (as if is for all of us). Institutions often make things worse by allowing the patient to believe he or she has no responsibility to control his or her behavior and that nothing is his or her fault. Institutions are easy to get into but hard to get out of. I wish your friend the best.

I'm interested in becoming a psychologist for the criminally insane. I'm a little confused as to what field of psychology I should go into to do this. From my research it looks like either criminal psychology or forensic psychology. However, I'm very interested in studying these people rather than just the typical "How does that make you feel?" of a psychologist. Any ideas?

By the way, hope this is not too petty an observation, but thought you might want to know that psychologists no longer say (if they ever did) "How does that make you feel?" It is assumed that nothing can "make" a person feel something, so psychologists might ask, "How do you feel about that?" Actually, that stuff mostly is not said in public mental hospitals. Often, the person involved has problems that go way beyond having a feeling about something. The question is more likely to be something like this: "John, what were thinking about right before you hit the supervisor?"

Sorry, can't give just one. I'd divide my worst experiences into 3 basic categories and I will give at least one example of each category.<br />
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1. Reading the files and meeting people who have been incredibly mistreated, especially children (they don't have kids here anymore but they did when I started). These stories are unbelievably horrible. Example: One child had been put out as a prostitute from the age of two. It damaged this child so much that the child had to have surgery for internal injuries. At the hospital, the child came to trust a nurse and told the nurse about the situation. The mother and uncle (mother's brother) were arrested, charged and released until trial. Everyone forgot about the child who was then discharged from the hospital into the custody of her mother and uncle! The uncle then stabbed the child 16 times and set the house on fire to cover the crime of murder. But the child survived due to a fast thinking neighbor. The child was so traumatized that she developed a rare mental disease, amnesia. It took her a year to regain her memory and, as she did so, she got angrier and angrier. Eventually, due to visits from her grandmother, she calmed down and began to heal. Her attorney went to court to have her custody changed from institutional to her grandmother...the court denied it because her grandmother was 70 years old, too old according to the court, even though the grandmother was working full time and looked half her age. The child has been forced to remain institutionalized. To her credit, she is doing the best she can to get an education and a good life. There are many of these horrifying stories here.<br />
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2. Dealing with administrators and school principals who were awful. Read my story about the hot coffee being hurled in my face and you will see that the administrators are often crazier than those incarcerated. Another example: Read my story about being accused of phoning a sex hotline. Most people who work here find these situations more upsetting than anything else here.<br />
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3. Being attacked: I got a head butt that caused a concusion on my first day on the job. I have had every ob<x>ject in the classroom hurled at me, including, for example, a computer printer--twice! (First, the student threw the computer printer at me and I ducked and it smashed into pieces. Then they replaced it. Then the same student threw the new one, same results). I have been in a mini-riot, in which students in their early teens broke every window in the school as they ran amuck. But my worst, most frightening situation occurred when a very delusional, very socially maladjusted patient went wild in the day hall of a unit and smashed a chair. He was a small guy and these were huge heavy chairs (designed not to be thrown!) so it was amazing that he could even lift one, let alone throw it. The chair smashed into bits and there were huge splinters. The patient picked up a two foot long splinter, with a very sharp point and began to thrust it at various people including me. I had come into the unit as a way of taking a shortcut to the Horticulture class I was then teaching and I was carrying a big bag of mulch. I, along with the other patients and staff, kept backing up and the patient kept moving toward us with his giant splinter until we were against the wall and still he kept coming. I decided that if he thrust the splinter at me, I'd hold up my bag of mulch as a shield. Just as he turned toward me and I got ready to lift the bag of mulch....the hospital police arrived. The patient, who was used to dealing with the police, immediately knelt down with his hands behind his back and it was over. It took me several weeks to get over the post traumatic stress.

I know our hospital has a huge accounting office and many other offices besides. I will ask around to see if medical coding/billing is done here. I will get back on here and post the answer to your question if and when I find out myself.

Sorry this too so long. Yes, they do use medical coding and billing people in the accounting part of the hospital.

I am a displaced medical coder and I have wondered for a long time if these high security prisons for the criminally insane have a medical billing procedure. I am of course assuming that the facilities have their own doctors, nurses and do their own procedures. I have wanted to be a medical coder for a criminally insane facility since I first began coding! Don't ask me why, it just intrigues me. :) Would you happen to know if there are insurance procedures done at these places, or at your own?